Healthy mind or healthy body ?

Since the seventeenth century, thinkers have wrestled with the mind–body problem that questions how our minds and bodies interact. René Descartes proposed in 1641 that our minds and bodies are two fundamentally separate entities and this division has carried on through history, and certainly seems alive and well in physical and mental wellbeing.

Times are changing and while some clinicians think that the connection between physical and mental health should be abandoned, there is still a long way to go. We know instinctively we can feel down when a cold won’t shift or a sports injury prevents us exercising. A long physical illness can lead to isolation and depression. And likewise, depression can exacerbate conditions such as eczema or psoriasis, or self-medicating with alcohol or drugs with the knock-on effects on health which that brings.

Dr Sean Cross, a Consultant Psychiatrist at the Maudsley and King’s College NHS Foundation Trusts, is a specialist in the overlap between physical and mental wellbeing. Speaking at a Maudsley Learning at Work panel discussion in January 2017, he says that ignoring the link between physical and mental wellbeing has a double impact on workers and the organisations that employ them.

He says that, currently, the way that health care is commissioned and provided observes a clear split between the body and the mind.

“It is also a problem that we have everywhere in society and our culture. It permeates into your work environments as work is an incredibly important place for most of us in our lifetimes.

“In order to fix this system, we need a big cultural shift in how we think about health and look at how we start to change medical training all the way through … so that when you are a patient – and all of us can be a patient at any point in our lives – you end with one professional who can at least try and hold it all.”

He added that, “If you have any ongoing physical health problem, the chances are that you can develop a mental health problem.”

“If you struggle with any ongoing health problem, diabetes, back pain, arthritis, bowel problems or headaches – it doesn’t really matter what it is – survey after survey shows that somewhere between 30 and 40 percent of people will also have depression or anxiety.

“Usually, if you end up in a GP’s surgery or you are seeing a specialist for your bowel problems and you raise an issue with anxiety or depression,’ you run into all the problems I mentioned earlier. ‘It’s a mental health issue. I’ll refer you on to someone else.’”

A consequence of people developing mental health issues is that they take their medication less, attend appointments less often, and are more likely to turn up at A&E and use unscheduled care. They tend to look after themselves less well and so their outcomes are worse.

This has significant implications for HR departments and line managers who may already be managing individuals with a primary mental health issue such as anxiety and depression, “They should be considering half of employees with any health problem which requires them to take leave from work, could develop a co-morbid mental health problem. If our HR departments, line managers and the infrastructures of our organisations are not confident in mental health literacy, then you start to exacerbate the problem.”

Employees are usually upfront about asking for time off to attend clinics for physical problems, so it is worth a line manager checking in from time to make sure that there is no knock-on effect on a colleague’s mental wellbeing.

Maudsley Learning at Work can help all employees to improve literacy and understanding of mental health issues, which is a starting point in beginning the discussion to find solutions before an issue becomes chronic. We don’t expect managers to diagnose or treat, but to create a work environment where a problem can be safely talked about and how help, which is often available at work or through the NHS, can be accessed without stigma.